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Wednesday, November 18, 2009

Now that new government guidelines are out on how to best care for your breasts, lesbians, bisexuals, and transgender women are left with a lot of questions.

For years medical professionals have advised women over the age of 40 to get annual breast exams as a way to detect cancerous tumors. However, the new guidelines from the U.S. Preventive Service Task Force, which shun breast self-exams and suggest only women between the ages of 50 and 74 get mammograms every other year, are startling to some, while others welcome the recommendations.

A majority of women, regardless of sexual orientation, are used to going to their doctors primarily for reproductive or breast health care, says Amber Hollibaugh, the chief officer of elder and LBTI women's services at the Lesbian Community Care Project of the Howard Brown Health Center in Chicago.

"As flawed as the system is, that's how women are taught," she told Advocate.com Tuesday. "When you go to a doctor, you're usually prompted to go by your reproductive health or breast cancer concerns. So the irony is that most women access all their health care using those two funnels. They come in and they say, 'I need a mammography. Oh, yeah, and I also ate a doughnut yesterday and passed out.' So then the doctor says, 'Well, I should go in and check you for diabetes.'"

The already low percentage of LBTI women going into medical facilities for reproductive and breast health issues could diminish even further with the task force's recommendations.

"If you're worried about cancer as a woman, but you have gender issues, like being a butch lesbian who doesn't want to do mammography, you're going to hesitate to access care in traditionally the only way that women typically get it," Hollibaugh said.

While the task force does suggest that the number of mammograms a woman receives should be established on a case-by-case basis, the overall recommendation would reduce the number of tests for the average woman, especially those under 50.

Officials with Susan G. Komen for the Cure, a top breast cancer advocacy organization, issued a statement Monday sayiing the previous guidelines should remain as a precaution.

"Mammography is not perfect, but is still our best tool for early detection and successful treatment of this disease," they said. They also pointed out that nearly a third of American women do not undergo regular testing.

Janelle Hail, the founder and CEO of the National Breast Cancer Foundation, called the task force's suggestion to stop conducting self-exams to be "dangerous."

"At 34 years old, I felt a lump while performing a breast self-exam," she said on her blog. "Concerned, I got a mammogram that detected breast cancer. If I had not had a breast self-exam and a mammogram, I would not be alive today and the National Breast Cancer Foundation would not exist."

The American Cancer Society also recommends regular screening after a woman turns 40, based on other research that was not considered by the Preventive Service Task Force.

"The most recent data show us that approximately 17% of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22% occurred in women diagnosed in their 50s. Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average risk women," society officials said in a statement.

The organization Breast Cancer Action, however, has long held the position that premenopausal screenings are unnecessary, due to false-negative results, false-positive results, and exposure to radiation from the actual mammograms.
Fran Visco, president of the National Breast Cancer Coalition also welcomed the recommendation, adding that she hopes the release of the information puts "screening and its limitations into proper perspective." She also urged health-care policy makers to carefully analyze the basis of the revised recommendations: "Women have been given different messages for years, but unfortunately those messages were not based on strong evidence. Women deserve the truth even when it is complicated. They can accept it.”